Callosal Fibers Research Articles

Callosal Fiber Length Scales with Brain Size According to Functional Lateralization, Evolution, and Development.

Brain size significantly impacts the organization of white matter fibers. Fiber length scaling, the degree to which fiber length varies according to brain size, was overlooked. We investigated how fiber lengths within the corpus callosum, the most prominent white matter tract, vary according to brain size. The results showed substantial variation in length scaling among callosal fibers, replicated in two large healthy cohorts (∼2000 human subjects, including both sexes). The underscaled callosal fibers mainly connected the precentral gyrus and parietal cortices, whereas the overscaled callosal fibers mainly connected the prefrontal cortices. The variation in such length scaling was biologically meaningful: larger scaling corresponded to larger neurite density index but smaller fractional anisotropy values; cortical regions connected by the callosal fibers with larger scaling were more lateralized functionally as well as phylogenetically and ontogenetically more recent than their counterparts. These findings highlight an interaction between interhemispheric communication and organizational and adaptive principles underlying brain development and evolution.SIGNIFICANCE STATEMENT Brain size varies across evolution, development, and individuals. Relative to small brains, the neural fiber length in large brains is inevitably increased, but the degree of such increase may differ between fiber tracts. Such a difference, if it exists, is valuable for understanding adaptive neural principles in large versus small brains during evolution and development. The present study showed a substantial difference in the length increase between the callosal fibers that connect the two hemispheres, replicated in two large healthy cohorts. Together, our study demonstrates that reorganization of interhemispheric fibers length according to brain size is intrinsically related to fiber composition, functional lateralization, cortical myelin content, and evolutionary and developmental expansion.

An estimation of the absolute number of axons indicates that human cortical areas are sparsely connected.

The tracts between cortical areas are conceived as playing a central role in cortical information processing, but their actual numbers have never been determined in humans. Here, we estimate the absolute number of axons linking cortical areas from a whole-cortex diffusion MRI (dMRI) connectome, calibrated using the histologically measured callosal fiber density. Median connectivity is estimated as approximately 6,200 axons between cortical areas within hemisphere and approximately 1,300 axons interhemispherically, with axons connecting functionally related areas surprisingly sparse. For example, we estimate that <5% of the axons in the trunk of the arcuate and superior longitudinal fasciculi connect Wernicke's and Broca's areas. These results suggest that detailed information is transmitted between cortical areas either via linkage of the dense local connections or via rare, extraordinarily privileged long-range connections.

Searching for optimal machine learning model to classify mild cognitive impairment (MCI) subtypes using multimodal MRI data

The intervention at the stage of mild cognitive impairment (MCI) is promising for preventing Alzheimer’s disease (AD). This study aims to search for the optimal machine learning (ML) model to classify early and late MCI (EMCI and LMCI) subtypes using multimodal MRI data. First, the tract-based spatial statistics (TBSS) analyses showed LMCI-related white matter changes in the Corpus Callosum. The ROI-based tractography addressed the connected cortical areas by affected callosal fibers. We then prepared two feature subsets for ML by measuring resting-state functional connectivity (TBSS-RSFC method) and graph theory metrics (TBSS-Graph method) in these cortical areas, respectively. We also prepared feature subsets of diffusion parameters in the regions of LMCI-related white matter alterations detected by TBSS analyses. Using these feature subsets, we trained and tested multiple ML models for EMCI/LMCI classification with cross-validation. Our results showed the ensemble ML model (AdaBoost) with feature subset of diffusion parameters achieved better performance of mean accuracy 70%. The useful brain regions for classification were those, including frontal, parietal lobe, Corpus Callosum, cingulate regions, insula, and thalamus regions. Our findings indicated the optimal ML model using diffusion parameters might be effective to distinguish LMCI from EMCI subjects at the prodromal stage of AD.

Altered White-matter Tract Property in Adults with Attention-deficit Hyperactivity Disorder

Although altered microstructure properties of white-matter tracts have been reported in children with attention-deficit/hyperactivity disorder (ADHD), findings from relatively few adult ADHD studies are inconsistent. This study aims to examine microstructural property over the whole brain in adults with ADHD and explore structural connectivities. Sixty-four medication-naïve adults with ADHD and 81 healthy adults received diffusion spectrum imaging. Generalized fractional anisotropy (GFA), an index indicating microstructural property, was calculated stepwise among 76 white-matter tracts. With the threshold-free clustering weighted method, the segments with the largest group difference were selected, and mean GFA (mGFA) values were calculated. Adults with ADHD had increased mGFA values in the segments located in the left frontal aslant tract, the right inferior longitudinal fasciculus, and the left perpendicular fasciculus, and reduced mGFA values in the segments located in the right superior longitudinal fasciculus (SLF) I, the left SLF II, the right frontostriatal tracts from dorsolateral prefrontal cortex and the ventrolateral prefrontal cortex, the right medial lemniscus, the right inferior thalamic radiation to the auditory cortex, and the callosal fibers. Additionally, the mGFA value of the right SLF I segment was associated with hyperactivity-impulsivity symptoms. Our findings suggest that white-matter tracts with altered microstructure properties are located within the attention networks, fronto-striato-thalamocortical regions, and those associated with attention and visual perception in adults with ADHD.

Auditory spatial cueing reduces neglect after right-hemispheric stroke: A proof of concept study

Spatial neglect after right-hemispheric stroke, characterized by the failure to attend or respond to the contralesional space, is a strong negative outcome predictor. Neglect is a supramodal syndrome affecting not only the visual but also the auditory modality. Preliminary studies used this audio-visual cross-modal effect to show short-lasting effects on attention towards the neglected space. The aim of the present study was to introduce a new technique of auditory stimulation combining the unspecific effect of music (i.e., patients choose their preferred music) with the effects of auditory spatial cueing (i.e., the music is presented dynamically as moving from right to left). The effect of this new auditory stimulation technique was investigated in two proof-of-concept experiments using repeated-measures, cross-over designs including 21 patients with visual neglect after a first right-hemispheric stroke. In Experiment I (n = 9), neglect patients showed a significantly larger improvement in Letter Cancellation after listening to preferred music with than without auditory spatial cueing. After granting the feasibility of this new auditory stimulation technique, we investigated the long-term aftereffects in Experiment II (n = 12). Herefore, we used video-oculography during Free Visual Exploration, a sensitive and reliable tool to assess spatial attention over time. Listening to music with auditory spatialcueing – as compared to music without auditory spatialcueing – significantly improved neglect severity in terms of visual exploration behaviour for up to 3h. A voxel-based-lesion-symptom mapping analysis over all patients revealed that the response variability in listening to music with auditory spatial cueing is determined by the integrity of the right inferior parietal lobule, the second branch of the superior longitudinal fascicle, and parieto-parietal callosal fibres. Our study shows that listening to music with auditory spatial cueing significantly reduces neglect severity and has the potential to be used as an add-on in the neurorehabilitation of neglect.

Effects of polygenic risk of schizophrenia on interhemispheric callosal white matter integrity and frontotemporal functional connectivity in first-episode schizophrenia.

Schizophrenia is a severely debilitating psychiatric disorder with high heritability and polygenic architecture. A higher polygenic risk score for schizophrenia (SzPRS) has been associated with smaller gray matter volume, lower activation, and decreased functional connectivity (FC). However, the effect of polygenic inheritance on the brain white matter microstructure has only been sparsely reported. Eighty-four patients with first-episode schizophrenia (FES) patients and ninety-three healthy controls (HC) with genetics, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (rs-fMRI) data were included in our study. We investigated impaired white matter integrity as measured by fractional anisotropy (FA) in the FES group, further examined the effect of SzPRS on white matter FA and FC in the regions connected by SzPRS-related white matter tracts. Decreased FA was observed in FES in many commonly identified regions. Among these regions, we observed that in the FES group, but not the HC group, SzPRS was negatively associated with the mean FA in the genu and body of corpus callosum, right anterior corona radiata, and right superior corona radiata. Higher SzPRS was also associated with lower FCs between the left inferior frontal gyrus (IFG)-left inferior temporal gyrus (ITG), right IFG-left ITG, right IFG-left middle frontal gyrus (MFG), and right IFG-right MFG in the FES group. Higher polygenic risks are linked with disrupted white matter integrity and FC in patients with schizophrenia. These correlations are strongly driven by the interhemispheric callosal fibers and the connections between frontotemporal regions.

Swallowing function in the chronic stage following stroke is associated with white matter integrity of the callosal tract between the interhemispheric S1 swallowing representation areas

Sensorimotor representations of swallowing in pre- and postcentral gyri of both cerebral hemispheres are interconnected by callosal tracts. We were interested in (1) the callosal location of fibers interconnecting the precentral gyri (with the primary motor cortex; M1) and the postcentral gyri (with the primary somatosensory cortex; S1) relevant for swallowing, and (2) the importance of their integrity given the challenges of swallowing compliance after recovery of dysphagia following stroke. We investigated 17 patients who had almost recovered from dysphagia in the chronic stage following stroke and age-matched and gender-matched healthy controls. We assessed their swallowing compliance, investigating swallowing of a predefined bolus in one swallowing movement in response to a ‘go’ signal when in a lying position. A somatotopic representation of swallowing was mapped for the pre- and postcentral gyrus, and callosal tract location between these regions was compared to results for healthy participants. We applied multi-directional diffusion-weighted imaging of the brain in patients and matched controls to calculate fractional anisotropy (FA) as a tract integrity marker for M1/S1 callosal fibers. Firstly, interconnecting callosal tract maps were well spatially separated for M1 and S1, but were overlapped for somatotopic differentiation within M1 and S1 in healthy participants’ data (HCP: head/face representation; in house dataset: fMRI-swallowing representation in healthy volunteers). Secondly, the FA for both callosal tracts, connecting M1 and S1 swallowing representations, were decreased for patients when compared to healthy volunteers. Thirdly, integrity of callosal fibers interconnecting S1 swallowing representation sites was associated with effective swallowing compliance. We conclude that somatosensory interaction between hemispheres is important for effective swallowing in the case of a demanding task undertaken by stroke survivors with good swallowing outcome from dysphagia.

Relationship Between Ipsilesional Upper Extremity Motor Function and Corpus Callosum Integrity in Patients With Unilateral Stroke: A Diffusion Tensor Imaging Study.

This study aims to investigate the relationship between ipsilesional upper extremity (UE) motor function and the integrity of the subregions of the corpus callosum in hemiparetic stroke patients with motor deficits of the dominant or non-dominant ipsilesional side. Twenty participants with unilateral UE deficits after stroke were included. Each of the 10 participants had lesions on the left and right sides. The ipsilesional UE function was assessed with the Jebsen-Taylor hand function test (JHFT), the 9-hole peg test (9HPT), and grip and pinch strength tests. Fractional anisotropy (FA) was calculated for the integrity of the 5 subregions of the corpus callosum. Pearson's correlation analysis was conducted to investigate the relationship between UE function and the integrity of the callosal subregions. The results of JHFT and 9HPT showed a significant correlation with the FA value of the corpus callosum I projecting to the frontal lobe in the left lesion group (p < 0.05). There was no correlation between the ipsilesional UE motor function and the FA value of the ulnar subregion in the right lesion group (p > 0.05). These results showed that the motor deficits of the ipsilesional UE correlated with the integrity of callosal fiber projection to the prefrontal area when the ipsilesional side was non-dominant.

Cortical thinning and white matter abnormalities relate to longitudinal neuropsychiatric symptoms differentially in predementia and dementia stages

AbstractBackgroundSubjects with cognitive impairment and dementia often suffer from neuropsychiatric symptoms (NPS). Recent studies reported the association between brain structural damages and NPS. However, little is known about how domains of NPS map to region‐specific multimodal macro‐ and micro‐structural brain changes and whether the patterns vary across different cognitive stages. Importantly, most existing evidence is cross‐sectional. Here, we sought to investigate how baseline cortical thickness (CTh) and white matter (WM) microstructure influenced longitudinal progression of NPS in predementia and dementia.MethodLongitudinal neuropsychiatric inventory (NPI) total severity and subsyndrome scores (Hyperactivity, Psychosis, Affective, Apathy) over 5 years were reported in 334 memory‐clinic patients (187 cognitive impairment no dementia (CIND) and 147 dementia). All participants underwent T1‐weighted structural and diffusion MRI at baseline. A free‐water (FW) imaging method was applied to derive individual‐level WM‐FW and tissue‐compartment maps from diffusion‐MRI. The grey matter (GM) CTh was derived using Freesurfer. We examined the association of baseline WM‐FW, WM‐tissue or GM‐CTh with baseline/longitudinal NPI (total severity and sub‐syndrome) using general linear models.ResultIn CIND, higher total NPI severity was associated with widespread WM‐FW increases (fronto‐parietal projection, temporal and callosal fibres) and more focal tissue fractional‐anisotropy (FAt) reductions (fronto‐parietal/callosal fibres) cross‐sectionally (Fig‐1). Specifically, such WM‐measures were associated with affective and hyperactive sub‐syndromes, but not with psychosis and apathy. No NPI‐cortical thickness association was detected in CIND. By contrast, in dementia, GM‐CTh in frontal executive and default mode and central sensory networks, but not WM‐alteration, was related to higher total NPI severity (Fig‐2). Also, GM‐CTh was associated with apathy and psychosis, but not with affective and hyperactive sub‐syndromes.Furthermore, baseline WM‐measures were associated with longitudinal changes in total NPI severity (Fig‐3) and affective and hyperactive in CIND. By contrast, no association was found between GM‐CTh and longitudinal NPI (total and subsyndromes) in dementia.ConclusionThis study demonstrated that WM‐abnormalities, which were early marker of disease, were related to NPS in CIND, while GM‐CTh was associated with NPS in dementia. Early identification and interventions should be developed for timely management of affective and hyperactive disorders, followed up by close monitoring of the progression of cerebral structural disruptions.

Stereotactic laser interstitial thermal therapy corpus callosotomy for the treatment of pediatric drug-resistant epilepsy.

ObjectiveCorpus callosotomy is a safe and effective procedure for reducing the frequency of drop attacks. MR‐guided laser interstitial thermal therapy (MRgLITT) offers a minimally invasive alternative to conventional open craniotomy for callosotomy. We hypothesized that MRgLITT callosotomy could be safely performed in pediatric patients with similar seizure control.MethodsWe present an institutional case series of 11 procedures in 10 patients for the treatment of drop attacks in drug‐refractory primary generalized epilepsy. MRgLITT was used for complete callosotomy, anterior two‐thirds, posterior, or ablation of residual callosal fibers following prior callosotomy (open or MRgLITT). We retrospectively reviewed clinical course, operative details, radiographic imaging, clinical outcomes, and complications.ResultsOperative time ranged from 4‐8 hours, and median hospitalization was 2 days. No complications were encountered. Among the 7 patients with at least 3 months of follow‐up, 71% experienced freedom from drop attacks at longest follow‐up and 57% of cases showed improvement in their other seizure semiologies as well (Engel Class II: 28%, Class III: 28%, Class IV: 43%).SignificanceMR‐guided LITT callosotomy is safe and effective modality in the management of pediatric patients with medically intractable epilepsy characterized by drop attacks. While this is among the largest pediatric series to date, further studies are required to delineate its safety and efficacy among such patients.

Changes in the Brain Connectome Following Repetitive Transcranial Magnetic Stimulation for Stroke Rehabilitation

Repetitive transcranial magnetic stimulation (rTMS) is a promising approach for post-stroke rehabilitation but there lacks a rationale strategy to plan, execute, and monitor treatment. We present a case of targeted rTMS using the Omniscient Infinitome software to devise targets for treatment in a post-stroke patient and describe the functional connectomic changes after treatment. A 19-year-old female with no medical history presented 19 months after suffering a left middle cerebral artery (MCA) superior division ischemic stroke, resulting in language impairment and diminished right upper extremity motor function. She underwent a resting-state MRI (rsMRI) with tractography and images were processed using the Omniscient Infinitome software. Analysis using the anomaly detection within the software enabled us to identify three targets for rTMS (left area 1, left area 45, and right area SFL). These areas were treated with 25 sessions of intermittent Theta Burst Stimulation (iTBS) over five days at 80% of motor threshold concomitantly with targeted physical therapy and speech therapy. At five months follow-up, her language and right upper extremity functions significantly improved. Her connectomic analysis revealed substantial neural changes, including normalization of the sensorimotor network, substantially thicker callosal fiber bundle connecting the two hemispheres, and increased cortical recruitment in her language network. We present the first description of robust connectomic alterations in a post-stroke patient following targeted rTMS treatment. Further studies on the use of rTMS with an emphasis on functional connectomics are warranted.

Connectivity-Based Topographical Changes of the Corpus Callosum During Aging.

Background: The corpus callosum (CC) is the most prominent white matter connection for interhemispheric information transfer. It is implicated in a variety of cognitive functions, which tend to decline with age. The region-specific projections of the fiber bundles with microstructural heterogeneity of the CC are associated with cognitive functions and diseases. However, how the CC is associated with the information transfer within functional networks and the connectivity changes during aging remain unclear. Studying the CC topography helps to understand the functional specialization and age-related changes of CC subregions.Methods: Diffusion tractography was used to subdivide the CC into seven subregions from 1,086 healthy volunteers within a wide age range (21–90 years), based on the connections to the cortical parcellations of the functional networks. Quantitative diffusion indices and connection probability were calculated to study the microstructure differences and age-related changes in the CC subregions.Results: According to the population-based probabilistic topography of the CC, part of the default mode network (DMN) and limbic network (LN) projected fibers through the genu and rostrum; the frontoparietal network (FPN), ventral attention network (VA) and somatomotor networks (SM) were interconnected by the CC body; callosal fibers arising from the part of the default mode network (DMN), dorsal attention network (DA) and visual network (VIS) passed through the splenium. Anterior CC subregions interconnecting DMN, LN, FPN, VA, and SM showed lower fractional anisotropy (FA) and higher mean diffusivity (MD) and radial diffusivity (RD) than posterior CC subregions interconnecting DA and VIS. All the CC subregions showed slightly increasing FA and decreasing MD, RD, and axial diffusivity (AD) at younger ages and opposite trends at older ages. Besides, the anterior CC subregions exhibited larger microstructural and connectivity changes compared with the posterior CC subregions during aging.Conclusion: This study revealed the callosal subregions related to functional networks and uncovered an overall “anterior-to-posterior” region-specific changing trend during aging, which provides a baseline to identify the presence and timing of callosal connection states.

Indices of callosal axonal density and radius from diffusion MRI relate to upper and lower limb motor performance

Understanding the relationship between human brain structure and functional outcome is of critical importance in systems neuroscience. Diffusion MRI (dMRI) studies show that fractional anisotropy (FA) is predictive of motor control, underscoring the importance of white matter (WM). However, as FA is a surrogate marker of WM, we aim to shed new light on the structural underpinnings of this relationship by applying a multi-compartment microstructure model providing axonal density/radius indices. Sixteen young adults (7 males / 9 females), performed a hand/foot tapping task and a Multi Limb Reaction Time task. Furthermore, diffusion (STEAM &HARDI) and fMRI (localizer hand/foot activations) data were obtained. Sphere ROIs were placed on activation clusters with highest t value to guide interhemispheric WM tractography. Axonal radius/density indices of callosal parts intersecting with tractography were calculated from STEAM, using the diffusion-time dependent AxCaliber model, and correlated with behavior. Results indicated a possible association between larger apparent axonal radii of callosal motor fibers of the hand and higher tapping scores of both hands, and faster selection-related processing (normalized reaction) times (RTs) on diagonal limb combinations. Additionally, a trend was present for faster selection-related processing (normalized reaction) times for lower limbs being related with higher axonal density of callosal foot motor fibers, and for higher FA values of callosal motor fibers in general being related with better tapping and faster selection-related processing (normalized reaction) times. Whereas FA is sensitive in demonstrating associations with motor behavior, axon radius/density (i.e., fiber geometry) measures are promising to explain the physiological source behind the observed FA changes, contributing to deeper insights into brain-behavior interactions.

Reduction of corpus callosum activity during whisking leads to interhemispheric decorrelation

Interhemispheric correlation between homotopic areas is a major hallmark of cortical physiology and is believed to emerge through the corpus callosum. However, how interhemispheric correlations and corpus callosum activity are affected by behavioral states remains unknown. We performed laminar extracellular and intracellular recordings simultaneously from both barrel cortices in awake mice. We find robust interhemispheric correlations of both spiking and synaptic activities that are reduced during whisking compared to quiet wakefulness. Accordingly, optogenetic inactivation of one hemisphere reveals that interhemispheric coupling occurs only during quiet wakefulness, and chemogenetic inactivation of callosal terminals reduces interhemispheric correlation especially during quiet wakefulness. Moreover, in contrast to the generally elevated firing rate observed during whisking epochs, we find a marked decrease in the activity of imaged callosal fibers. Our results indicate that the reduction in interhemispheric coupling and correlations during active behavior reflects the specific reduction in the activity of callosal neurons.

Corpus Callosum and Its Connections: A Fiber Dissection Study

We performed a fine white fiber dissection to demonstrate the extensive connections of the corpus callosum. Three formalin-fixed frozen cadaveric human brain specimens were dissected using Klingler's technique. On one half of each hemisphere, the superior connections of the corpus callosum were dissected and in the other half the inferior connections of the corpus callosum were dissected. The mean length of the corpus callosum from the rostrum to the splenium was 7.8 cm. The fibers of the corpus callosum were classified as superior/dorsal radiations, inferior/ventral radiations, anterior radiations, and posterior radiations. The entire transverse length of the dorsal callosal radiation from one hemisphere to the other was 8.1 cm. For anterior interhemispheric approaches, an incision in the anterior part of the body not extending beyond 3.5 cm from the genu was found to be safe with regards to crossing motor fibers. The corpus callosum was found to have intricate connections with all the lobes of the cerebral hemispheres, including the insular region and the limbic and paralimbic areas. Based on the course and traverse of the callosal fibers, a transverse incision in the corpus callosum should be preferred when performing a callosotomy to access intraventricular lesions as this splits the callosal fibers instead of transecting them. The analysis of the course of the callosal radiations enhances understanding of the growth pattern of primary corpus callosal gliomas and helps to design a safe surgical strategy.

The supplementary motor area syndrome: a neurosurgical review.

The supplementary motor area (SMA) syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function and the dominant pre-SMA specifically is associated with more complex language functions; the SMA is furthermore incorporated in the negative motor network. The SMA has a rich interconnectivity with other cortical regions and subcortical structures using the frontal aslant tract (FAT) and the frontostriatal tract (FST). The development of the SMA syndrome is positively correlated with the extent of resection of the SMA region, especially its medial side. This may be due to interruption of the nearby callosal association fibres as the contralateral SMA has a particular important function in brain plasticity after SMA surgery. The syndrome is characterized by a profound decrease in interhemispheric connectivity of the motor network hubs. Clinical improvement is related to increasing connectivity between the contralateral SMA region and the ipsilateral motor hubs. Overall, most patients know a full recovery of the SMA syndrome, however a minority of patients might continue to suffer from mild motor and speech dysfunction. Rarely, no recovery of neurological function after SMA region resection is reported.

Integrity of the Prefronto-striato-thalamo-prefrontal Loop Predicts Tai Chi Chuan Training Effects on Cognitive Task-switching in Middle-aged and Older Adults.

Tai Chi Chuan (TCC) exercise has been shown to improve cognitive task-switching performance in older adults, but the extent of this positive effect varies among individuals. Past research also shows that brain white matter integrity could predict behavioral gains of cognitive and motor learning. Therefore, in this randomized controlled trial (NCT02270320), we examined whether baseline integrity of three target white matter tract groups was predictive of task-switching improvement after 12-week TCC training in middle-aged and older adults. Thirty-eight eligible participants were randomly assigned to a TCC group (n = 19) and a control group (n = 19). Cognitive task-switching and physical performances were collected before and after training. Brain diffusion spectrum MR images were acquired before training and the general fractional anisotropy (GFA) of each target white matter tract group was calculated to indicate baseline white matter integrity of that group. Correlation and regression analyses between these GFAs and post-training task-switching improvement were analyzed using adjusted p-values. After 12 weeks, significant task-switching and physical performance improvements were found only in the TCC group. Moreover, higher baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers (r = −0.63, p = 0.009), but not of the prefronto-parietal/occipital (r = −0.55, p = 0.026) and callosal (r = −0.35, p = 0.189) fiber groups, was associated with greater reductions of task-switching errors after the TCC training. Multiple regression analysis revealed that baseline GFA of the prefronto-striato-thalamo-prefrontal loop fibers was the only independent white matter integrity predictor of task-switching error reductions after TCC training (β = −0.620, adjusted R2 change = 0.265, p = 0.009). These findings not only highlight the important role of baseline integrity of the prefronto-striatal circuits in influencing the extent of positive cognitive task-switching effects from short-term TCC training, but also implicate that preserving good white matter integrity in the aging process may be crucial in order to gain the best cognitive effects of exercise interventions.

Evidence for interhemispheric imbalance in stroke patients as revealed by combining transcranial magnetic stimulation and electroencephalography.

Interhemispheric interactions in stroke patients are frequently characterized by abnormalities, in terms of balance and inhibition. Previous results showed an impressive variability, mostly given to the instability of motor‐evoked potentials when evoked from the affected hemisphere. We aim to find reliable interhemispheric measures in stroke patients with a not‐evocable motor‐evoked potential from the affected hemisphere, by combining transcranial magnetic stimulation (TMS) and electroencephalography. Ninteen stroke patients (seven females; 61.26 ± 9.8 years) were studied for 6 months after a first‐ever stroke in the middle cerebral artery territory. Patients underwent four evaluations: clinical, cortical, corticospinal, and structural. To test the reliability of our measures, the evaluations were repeated after 3 weeks. To test the sensitivity, 14 age‐matched healthy controls were compared to stroke patients. In stroke patients, stimulation of the affected hemisphere did not result in any inhibition onto the unaffected. The stimulation of the unaffected hemisphere revealed a preservation of the inhibition mechanism onto the affected. This resulted in a remarkable interhemispheric imbalance, whereas this mechanism was steadily symmetric in healthy controls. This result was stable when cortical evaluation was repeated after 3 weeks. Importantly, patients with a better recovery of the affected hand strength were the ones with a more stable interhemispheric balance. Finally, we found an association between microstructural integrity of callosal fibers, suppression of interhemispheric TMS‐evoked activity and interhemispheric connectivity. We provide direct and sensitive cortical measures of interhemispheric imbalance in stroke patients. These measures offer a reliable means of distinguishing healthy and pathological interhemispheric dynamics.

Control of drop attacks with selective posterior callosotomy: Anatomical and prognostic data

ObjectiveIn a previous proof of concept study, selective posterior callosotomy achieved similar degree of control of drop attacks as total callosotomy, while sparing prefrontal interconnectivity. The present study aims to confirm this finding in a larger cohort and to provide anatomical and prognostic data. MethodsFifty-one patients with refractory drop attacks had selective posterior callosotomy and prospective follow up for a mean of 6.4 years. Twenty-seven patients had post-operative magnetic resonance imaging (MRI) and 18 had tractography (DTI) of remaining callosal fibers. Pre and postoperative falls were quantified and correlated with demographic, clinical and imaging data. ResultsMean monthly frequency of drop attacks had a 95 % reduction, from 297 before to 16 after the procedure. Forty- one patients (80 %) had either complete or greater than 90 % control of the epileptic falls. Age and duration of epilepsy at surgery correlated with outcome (p values, respectively, 0.042 and 0.005). Mean index of callosal section along the posterior-to-anterior axis was 53.5 %. Extending the posterior section anterior to the midbody of the corpus callosum did not correlate with seizure control (p 0.91), providing fibers interconnecting the primary motor (M1) and caudal supplementary motor areas (SMA) were sectioned. Only one patient had a notable surgical complication which resolved in two days. ConclusionsThis level III cohort study with objective outcome assessment confirms that selective posterior callosotomy is safe and effective to control epileptic falls. Younger patients with smaller duration of epilepsy have better results. A posterior section contemplating the splenium, isthmus and posterior half of the body (posterior midbody) seems sufficient to achieve complete or almost complete control of drop attacks.

White matter network disruption and cognitive correlates underlying impaired memory awareness in mild cognitive impairment

Decreased awareness of memory declines in mild cognitive impairment (MCI) has been linked to structural or functional changes in a wide gray matter network; however, the underlying white matter pathway correlations for the memory awareness deficits remain unknown. Moreover, consistent findings have not been obtained regarding the cognitive basis of disturbed awareness of memory declines in MCI. Due to the methodological drawbacks (e.g., correlational analysis without controlling confounders related to clinical status, a problem related to the representativeness of the control group) of previous studies on the aforementioned topic, further investigation is required. To addressed the research gaps, this study investigated white matter microstructural integrity and the cognitive correlates of memory awareness in 87 older adults with or without mild cognitive impairment (MCI). The patients with MCI and healthy controls (HCs) were divided into two subgroups, namely those with normal awareness (NA) and poor awareness (PA) for memory deficit, according to the discrepancy scores calculated from the differences between subjective and objective memory evaluations. Only the results for HCs with NA (HC-NA) were compared with those for the two MCI groups (i.e., MCI-NA and MCI-PA). The three groups were matched on demographic and clinical variables. An advanced diffusion imaging technique—diffusion spectrum imaging—was used to investigate the integrity of the white matter tract. The results revealed that although the HC-NA group outperformed the two MCI groups on several cognitive tests, the two MCI groups exhibited comparable performance across different neuropsychological tests, except for the test on reasoning ability. Compared with the other two groups, the MCI-PA group exhibited lower integrity in bilateral frontal-striatal fibers, left anterior thalamocortical radiations, and callosal fibers connecting bilateral inferior parietal regions. These results could not be explained by gray matter morphometric differences. Overall, the results indicated that mnemonic anosognosia was not sufficient to explain the memory awareness deficits observed in the patients with MCI. Our brain imaging findings also support the concept of anosognosia for memory deficit as a disconnection syndrome in MCI.